Remission is a key treatment target in systemic lupus erythematosus (SLE) management. Given the direct correlation between lupus flares and elevated risks of adverse pregnancy outcomes (APOs), securing remission before conception becomes crucial. However, the association between clinical remission with active serology, and the risk of APOs is not thoroughly understood. Additionally, determining the optimal glucocorticoid dosage during pregnancy to mitigate APO risks remains under-researched. This study investigated the risk of APOs in relation to remission/serological activity status in patients in clinical remission/glucocorticoid dosage. Pregnant patients with SLE, who were followed up at two Japanese tertiary referral centers, and had their remission status assessed at conception, were included in this study. We categorized the patients into two groups based on whether they achieved Zen/Doria remission at conception and analyzed the APO ratio. We also examined the influence of serological activity in pregnant patients with clinical remission and analyzed the optimal glucocorticoid dosage to minimize the APO ratio. Of the 96 pregnancies included, 59 achieved remission at conception. Pregnant patients who achieved remission showed a significant decrease in the APO ratio compared with those who did not. (overall APO: odds ratio (OR) 0.27, 95% confidence interval (CI) 0.11–0.65, p < 0.01, maternal APO: OR 0.34, 95%CI 0.13–0.85, p = 0.021, neonatal APO: OR 0.39, 95%CI 0.17–0.90, p = 0.028). Conversely, no statistical difference was observed in the APO ratio based on serological activity in pregnant patients with clinical remission. (overall APO: OR 0.62, 95%CI 0.21–1.79, p = 0.37, maternal APO: OR 1.25, 95%CI 0.32–4.85, p = 0.75, neonatal APO: OR 0.83, 95%CI 0.29–2.39, p = 0.73). A glucocorticoid dose of prednisolone equivalent ≥ 7.5 mg/day at conception correlated with increased APO. (overall APO: OR 3.01, 95%CI 1.23–7.39, p = 0.016, neonatal APO: OR 2.98, 95% CI:1.23–7.22, p = 0.016). Even with active serology, achieving clinical remission can be a clinical target for reducing APOs in patients who wish to conceive. In addition, if clinically feasible, reducing the glucocorticoid dosage to < 7.5 mg/day before conception could be another predictive factor.

中文翻译：

---

缓解、主动血清学临床缓解和糖皮质激素剂量对系统性红斑狼疮妊娠患者妊娠结局的影响

缓解是系统性红斑狼疮 (SLE) 治疗的关键治疗目标。鉴于狼疮发作与不良妊娠结局 (APO) 风险升高之间存在直接相关性，因此在受孕前确保病情缓解变得至关重要。然而，主动血清学检测带来的临床缓解与 APO 风险之间的关联尚不完全清楚。此外，确定妊娠期间减轻 APO 风险的最佳糖皮质激素剂量的研究仍然不足。本研究调查了临床缓解/糖皮质激素剂量患者的 APO 风险与缓解/血清学活性状态相关。本研究纳入了患有系统性红斑狼疮的孕妇，她们在两个日本三级转诊中心进行了随访，并在受孕时评估了她们的缓解状态。我们根据患者在受孕时是否达到 Zen/Doria 缓解将患者分为两组，并分析 APO 比率。我们还检查了血清学活性对临床缓解的妊娠患者的影响，并分析了最佳糖皮质激素剂量，以尽量减少 APO 比率。在纳入的 96 例妊娠中，有 59 例在受孕时达到缓解。与未获得缓解的孕妇相比，获得缓解的孕妇的 APO 比率显着下降。（总体 APO：优势比 (OR) 0.27，95% 置信区间 (CI) 0.11–0.65，p < 0.01，母亲 APO：OR 0.34，95%CI 0.13–0.85，p = 0.021，新生儿 APO：OR 0.39，95 %CI 0.17–0.90，p = 0.028）。相反，在临床缓解的妊娠患者中，基于血清学活性的 APO 比率没有观察到统计学差异。（总体 APO：OR 0.62，95%CI 0.21–1.79，p = 0.37，母亲 APO：OR 1.25，95%CI 0.32–4.85，p = 0.75，新生儿 APO：OR 0.83，95%CI 0.29–2.39，p = 0.73）。受孕时泼尼松龙当量的糖皮质激素剂量≥7.5 mg/天与 APO 增加相关。（总体 APO：OR 3.01，95% CI 1.23–7.39，p = 0.016，新生儿 APO：OR 2.98，95% CI：1.23–7.22，p = 0.016）。即使采用积极的血清学检测，实现临床缓解也可以成为希望怀孕的患者减少 APO 的临床目标。此外，如果临床可行，受孕前将糖皮质激素剂量减少至< 7.5 mg/天可能是另一个预测因素。